Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, August 29, 2013

This Seems To Be A Trend That Is Worth Watching The Private Sector Stepping Up In E-Health.

This appeared last week.

At your fingertips

19 August, 2013
A growing number of practices are offering online services that benefit their patients and their business.
General practices used to only interact with patients in person or over the phone. Now they’re starting to offer online services through their websites, including booking appointments and receiving test results, referral letters and repeat scripts.
Bondi Junction Medical Centre in Sydney began offering online services in March and the experience has been highly satisfying, says practice manager Rakesh Vyasabhattu.
The benefits reaped by the GPs are primarily time saved and extra income. For example, the GP and patient agree beforehand that test results will be available online for the set fee of $20.
The GP then simply ticks a box in the medical record and the patient, who registers on the practice website with a user name and password, accesses the results when they’re ready, without having to ring the GP, says Mr Vyasabhattu.
Referral letters and repeat scripts are also available for a fee of $20, while booking appointments is free at the centre. The convenience is what appeals to many patients, Mr Vyasabhattu says.
“They don’t have to ring and be put on hold; they can access us and do these things 24/7,” he says.
“For our receptionists, the main benefit is less time taking phone calls, which makes them more available to speak to patients at the reception desk and also respond to the needs of the doctors.”
Online service providers
Online services made available through practice websites are in the early days of uptake. Heather Grain, director of course development at eHealth Education and council member at the Australasian College of Health Informatics, estimates that fewer than 10% of practices in Australia are currently offering these services through their website.
“The level is much higher in countries like the UK where the government strategy has been driving the uptake, whereas in Australia, the government focus has been on IT communications related to clinical care,” she says.
“As a result, private companies, as well as GP enthusiasts, are driving the uptake of online services through practice websites.”
These companies provide online services either embedded into a practice’s existing website or include them as part of a package of setting up a new practice website. These companies also can provide e-consultation capability, practice newsletters and patient health information for the website.
Practices that don’t have a website can use providers for online booking appointments such as 1stAvailable and Health Engine.
Lots more here:
What needs to be noticed here is the services that are being offered are the services patients want and that are not deliverable via the PCEHR. They are also being provided by private and not government entities.
To be able to make appointments, provide script repeats, provide referrals and access to test results you need to be to interact with a live local clinical system and not an delayed secondary and possibly incomplete system.
Combine this structural problem with the user unfriendliness of the current implementation and it is clear the PCEHR is a major failed design in terms of really delivering what patients actually want and would value.
Practitioners may also find the level of engagement with their patients and the additional income that is possible rather a win-win.
As the title says, well worth watching how this plays out in the future.
David.

Wednesday, August 28, 2013

It’s Wonderful To See Some Real Evidence Of E-Health In Australia Making A Difference - Again In The Private Sector.

This abstract appeared in the Medical Journal Of Australia last week.

Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews

Leelani K Wickramasinghe, Peter Schattner, Marienne E Hibbert, Joanne C Enticott, Michael P Georgeff and Grant M Russell
Med J Aust 2013; 199 (4): 261-265.
doi: 10.5694/mja13.10161
Abstract
Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.
Design, participants and setting: A before-and-after study to analyse prospectively collected data on 577 patients with type 1 or 2 diabetes mellitus who were managed with a GPMP created using cdmNet between June 2008 and November 2012.
Main outcome measures: Completion of the clinical tests in the ACOC (process outcome) and values of six of these clinical measurements (clinical outcomes).
Results: Significant improvements were seen after creation of a GPMP in the proportion of ACOC clinical tests completed (57.9% v 74.8%, P < 0.001), total cholesterol level (P < 0.01), low-density lipoprotein (LDL) cholesterol level (P < 0.001) and body mass index (BMI) (P < 0.01). Patients using GPMPs and TCAs also improved their glycated haemoglobin (HbA1c) level (P < 0.05). Patients followed up with irregular reviews had significant improvements in the proportion of ACOC clinical tests completed (59.2% v 77.6%, P < 0.001), total cholesterol level (P < 0.05), and BMI (P < 0.01), but patients with regular reviews had greater improvements in the proportion of ACOC clinical tests completed (58.9% v 85.0%, P < 0.001), HbA1c level (57.7 v 53.0 mmol/mol, P < 0.05), total cholesterol level (4.8 v 4.5 mmol/L, P < 0.05), LDL cholesterol level (2.8 v 2.4 mmol/L, P < 0.01) and diastolic blood pressure (76.0 v 74.0 mmHg, P < 0.05).
Conclusion: There were significant improvements in process and clinical outcomes for patients on a GPMP or a GPMP and TCA, particularly when these were followed up by regular reviews. Patients using cdmNet were four times more likely to have their GPMP or TCA followed up through regular reviews than the national average.
The article is here (full access freely accessible):
I was also sent a press release with some commentary:
Melbourne 19 August 2013
MEDIA RELEASE
INTERNET TECHNOLOGIES MAY BE KEY TO TREATING ‘FASTEST GROWING EPIDEMIC IN HUMAN HISTORY’ STUDY SUGGESTS
As diabetes looms as a runaway epidemic in Australia, a Monash University study suggests that Internet technologies may be key to overcoming this challenge to our healthcare system.  
The study monitored 577 diabetes patients over 14 months. It showed significant improvements in quality of care and clinical outcomes for patients whose care was supported by an internet-based care management service called cdmNet. The study is published in the Medical Journal of Australia issue of 19 August.
cdmNet assists General Practitioners (GPs) and patients to manage chronic diseases and other illnesses.  Using cdmNet, any member of the patient’s care team can access the patient’s health record and care plan, including the GP, specialists, allied health, pharmacists, and the patient themselves. They can do this from anywhere, anytime, while maintaining data privacy and security. Everyone on the team knows what everyone else is doing, all the time.
The results of the study show that 80% of patients on a care plan created and managed using cdmNet were regularly reviewed and followed up compared with national figures indicating fewer than 20% follow up of (non-cdmNet) patients. 
Furthermore, of those patients who received regular reviews, 85% adhered to best practice care compared with 59% otherwise.
Comparing patients before and after the use of cdmNet, significant improvements were observed in
·         HbA1c*, the surrogate measure of blood glucose levels, fell from a mean of 8.4% to 7.4% for patients with an initially high HbA1c
·         Lower total cholesterol (4.6 to 4.3 mmol/L); and
·         Lower LDL (bad) cholesterol (2.6 to 2.3 mmol/L)
The greatest improvements were in patients who had regular reviews of their care plan.
Professor Michael Georgeff, CEO of Precedence Health Care, the company that developed cdmNet, said the study suggests that improvement in clinical outcomes is related to the level of coordination among the care team and with the patient. It also indicates that patients are more likely to adhere to their plan when it is regularly reviewed and followed up by the GP and the care team.
“How to put this into practice is the challenge. GPs’ waiting rooms are full of people with a chronic illness. Trying to keep track of what everyone is doing or not doing places a huge burden on GPs and practices, especially when communications among the team are limited to fax, telephone tag and hand delivery of patient information.
“Without the use of advanced Internet and mobile technologies, one simply cannot achieve the level of coordination and follow up needed for these patients.
“More than seven million Australians have a chronic disease, costing the health care system more than $70 billion per year. The losses to the economy through reduced workforce participation rates and productivity are more than $8 billion per year. Diabetes alone accounts for nearly a quarter of avoidable hospitalisations and 9% of deaths.
“It will be impossible to maintain a sustainable health care system without the use of these technologies,” Professor Georgeff said.
For GPs on the front line who have adopted cdmNet as a patient management tool, the results speak for themselves. Dr Tim Denton, GP in Anglesea, Victoria and chair of the Barwon Medicare Local, said: "Since using cdmNet for ensuring quality of care, we have not had any amputations, strokes or progressive retinopathy in our patients with diabetes. People have fewer complications, are living better lives and living longer."  
Professor Paul Zimmet, AO, Director Emeritus at the Baker IDI Heart and Diabetes Institute and Adjunct Professor at Monash doesn’t hold back on the level of concern he holds for the “rise and rise” of diabetes in Australia.
“Diabetes in the 21st century is the equivalent of cholera in the 19th century and HIV/AIDS in the 20th century. During this millennium, diabetes is well on the way to cementing its place as the fastest growing epidemic in human history. And the situation in Australia is daunting both from the personal cost to individuals for medical and support care and the economic cost to the nation due to reduced national productivity as type 2 diabetes is now affecting the workforce age group and even children and adolescents.
“In Australia, there are at least 1.5 million known cases of diabetes and a similar number with pre-diabetes. Moreover, for every diagnosed person with diabetes, there is likely to be one undiagnosed case. So, we are looking at potentially more than 4 million people, either with diabetes or who are at risk. It is possible therefore that some 20% of the Australian population is affected by diabetes in some way.
“The medium to long-term answer, of course, is prevention. But, in the meantime, to reduce the burden of this epidemic, people with diabetes require comprehensive support and care from a whole range of allied health professionals along with GPs and specialists. It is a unique healthcare challenge and its treatment is best administered through a management plan involving a complete care team.
“Web-based tools appear to enable this kind of care more easily and, as the Monash study indicates, clinical outcomes are worthwhile and likely to reduce the burden of the sometimes devastating complications of diabetes.
“Diabetes is potentially the greatest epidemic in the history of world. By 2020, the condition will bankrupt the economies of many nations unless urgent action is taken,” Professor Zimmet added.
For further information
Professor Michael Georgeff
CEO Precedence Health Care
Mobile + 61 411 193 247
Office +61 3 9023 0800 during business hours
The release is here:
I think this is really very encouraging and shows how sensible planned progress can make a difference as compared with expensive overly complex and ambitious national programs.
Well worth reading the full paper.
David.

Tuesday, August 27, 2013

The Coalition Is Planning A PCEHR Review - What Should We See From The Review.

As I mentioned last week we found this late in the week from Coalition Policy.
In the full .pdf of the policy a review of the PCEHR is mentioned.
Page 15:
"Health professionals will be increasingly reliant on effective e-health tools to better
coordinate care, particularly for patients with complex health conditions.  Unfortunately, the Labor Government has failed to deliver on its Personally Controlled Electronic Health Record (PCEHR).
Despite the $1 billion price tag, only 4,000 records are reported to be in existence. In recent weeks, the clinical advisers for Labor's e-health record program have quit  en masse, leaving the Federal Government's flagship programme floundering with virtually no clinical oversight.
If elected, the Coalition will undertake a comprehensive assessment of the true status of the PCEHR implementation. In government, the Coalition implemented successful incentives to computerise general practice and will continue to provide strong in principle support for a shared electronic health record for patients. The Coalition will again work with health professions and industry to prioritise implementation following a full assessment of the current situation."
 Here is the link.
For me the review has to address the following.
First we need to know just where the implementation of the PCEHR is actually up to and just what levels of usage it is seeing - separate from the spin being put out by DoHA. We also need to understand where all the money has gone, who has profited and if there has been any issues like have been seen with the Qld Health payroll procurement and implementation.
Second we need a serious evidence based review of the options for having what has been built actually be used better and to have it actually achieve the desired health and clinical - and not technical outcomes. My feeling if this is done it will be concluded that the design of PCEHR is fatally flawed from both a clinical and patient utility point of view and needs a pretty large scale re-design. The opportunity cost of not correcting course and starting to invest in approaches that are more likely to work and deliver the Health Sector benefits we need is huge I believe.
Third - with a clear idea of what might work and where our gaps are - we need to plan how we migrate from where we are to where we need to be. The plan needs to be stakeholder and benefits focussed.
Lastly we really need to come up with an approach to the leadership and governance of the e-Health domain that much better manages the power of government, vendor needs for profit and opportunity, consumer requirements and the clinician’s need for quality and safe Health-IT. We need to properly balance all these interests while ensuring proper accountability on the part of each stakeholder.
A Clayton’s review is really not an option as all that will result in is good money being thrown after bad. Of course, the review needs to be made fully public
Remember e-Health is not intrinsically a good. To make a difference it has to be done well with co-operation and commitment from all.
David.

A Few Comments On The Election Health Debate - August 27, 2013

1. The two debaters were Ms Tanya Plibersek (Labor) and Mr Peter Dutton (Coalition).

2. Mr Dutton raised the PCEHR debacle in his introductory comments. Said that the PCEHR program was going to be reviewed and that the Coalition had done better in e-Health when in power last - citing GP usage of computers going from 17% to 90%+.

3. However in the debate proper there was not a single comment on e-Health.

4. I would believe overall Ms Plibersek was clearly more on top of the issues than Mr Dutton - however you mileage may vary.

5. No e-Health mentions in the the summary given at the end of the debate and no e-Health questions from the Press.

David.



Don't Forget - Election 2013 Health Policy Debate - 11:30am - Details Below.

Election 2013 Health Policy Debate

The Hon Tanya Plibersek MP Vs the Hon Peter Dutton MP

August 27, 2013

11.30am - 1.30pm

Here is the link:
Both Sky News and ABC News 24 typically carry these events live.
See here for example:
David.

Monday, August 26, 2013

Weekly Australian Health IT Links – 26th August, 2013.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Worst bit of news this week was the article showing the senior DoHA executives were getting nice bonuses as hundreds of staff are being fired. Hardly a good look.
Otherwise we see the Qld Payroll debacle finally played out with some accountability imposed on a few bureaucrats. I wonder will we ever see anything flow from the PCEHR debacle.
Last we have continuing outcomes from the clinical resignations from NEHTA. I suspect there will be ongoing news and ructions from this.
-----

PCEHR consent concerns rejected

20th Aug 2013
THE health department has rejected allegations that Australians signing up to the personally controlled e-health record (PCEHR) have been encouraged to do so without being given fully informed consent regarding how their information will be used.
The Australian Privacy Foundation (APF) said the PCEHR had been designed “to suit the needs of government, not patients”.
“Patients demand a careful balance between their rights to privacy and the government’s insatiable desire to collect, control and exploit personal data,” the APF said yet.
-----

Haikerwal decision to quit 'not made lightly

19 August, 2013 Paul Smith
Dr Mukesh Haikerwal (pictured) was head of clinical leadership at NEHTA for six years, but last week it emerged he had resigned along with other senior members of NEHTA's clinical unit, which had been set up to provide oversight and clinical input into the system.
In a statement, the former AMA president said: "My decision to move on from my role with NEHTA has not been made lightly, and of course there is never a 'good time' to take this step. 
"However, with the e-health system now in its current place and moving into a different phase, this is the right time for me to step aside."
-----

AMA raises concerns about NEHTA resignation

08.19.13
Australian Medical Association President, Dr Steve Hambleton, has responded to the resignation of Dr Mukesh Haikerwal, head of clinical leadership and stakeholder management, from the National Electronic Health Transition Authority (NEHTA).
In a statement Dr Hambleton said it raises serious concerns about clinical input to decision-making in the implementation of the Personally Controlled Electronic Health Record (PCEHR).
The resignations of Dr Haikerwal, a former AMA President and NHHRC Commissioner, and other clinical leads, including Dr Nathan Pinksier, come amid reports that the Department of Health and Ageing (DoHA) is taking over engagement with the medical profession and IT industry over the design of the PCEHR.
-----

Coalition slams Labor’s “$1bn e-health debacle”

news Shadow Health Minister Peter Dutton has taken a pickaxe to the Federal Government’s Personally Controlled Electronic Health Record (PCEHR) scheme, claiming the costly project was “more about spin than about outcomes for patients”.
The project was initially funded in the 2010 Federal Budget to the tune of $466.7 million after years of the health industry and technology experts calling for development and national leadership in e-health and health identifier technology to better tie together patients’ records and achieve clinical outcomes. The project is overseen by the Department of Health and Ageing in coalition with the National E-Health Transition Authority (NEHTA).
However, last month the Government revealed it had failed to meet it initial 500,000 target for adoption of the system, with only close to 400,000 Australians using the system at that point.
-----

How to save the PCEHR

The PCEHR belongs to Australians, not the government. It is our tax money, our data, our health, our work. NEHTA and the Department of Health have not been able to manage the project successfully over the past years and the governance of the PCEHR should be handed over to an independent council as soon as possible.
The resignation of NEHTA’s top National Clinical Leads last week was the final straw. I have said it before and I will say it again: if clinicians are not on board the PCEHR will fail. There are some big decisions to make by the relevant authorities if they want to save the project, and making these decisions without clinical advice is impossible.
-----

Alert over PCEHR pathology plan

20 August, 2013 Paul Smith
A Federal Government plan to extract pathology results from GP software and upload them onto the billion-dollar e-health scheme is sparking fears about patient safety.
The idea was apparently hatched by NEHTA and the Department of Health and Ageing without consultation, but is meant to help doctors and other health professional using the personally controlled e-health records system improve patient care.
However, pathologists and GPs have pointed out that uploading the results would give an incomplete and potentially misleading clinical picture, given the wide variations in the methods of pathology reporting.
-----

Clinical Safety and Data Duplication

Posted on August 21, 2013 by Grahame Grieve
Here’s how to kill patients:
<manufacturedProduct>
  <manufacturedMaterial>
    <code code="4683L" codeSystem="1.2.36.1.2001.1005.22" 
      codeSystemName="Australian PBS Code" 
      displayName="Kaltostat (168212) 7.5 cm x 12 cm dressing medicated" />
    <name>Atenolol</name>
  </manufacturedMaterial>
  <manufacturerOrganization>
    <id root="1.2.36.1.2001.1005.23" extension="CC" 
       assigningAuthorityName="Australian PBS Manufacturer Code" />
  </manufacturerOrganization>
</manufacturedProduct>
This is a fragment of a presription taken from a real CDA document (not in a production system, though).
The problem here is that the code and the name identify different medications. Presumably, the prescriber intended one, and the software supplied the other in error.
-----

At your fingertips

19 August, 2013 John Kron
A growing number of practices are offering online services that benefit their patients and their business.
General practices used to only interact with patients in person or over the phone. Now they’re starting to offer online services through their websites, including booking appointments and receiving test results, referral letters and repeat scripts.
Bondi Junction Medical Centre in Sydney began offering online services in March and the experience has been highly satisfying, says practice manager Rakesh Vyasabhattu.
The benefits reaped by the GPs are primarily time saved and extra income. For example, the GP and patient agree beforehand that test results will be available online for the set fee of $20.
-----

Doctors and DoHA hold eHealth crisis talks

Published on Fri, 23/08/2013, 09:40:42
By Julian Bajkowski
The Australian Medical Association (AMA) has held crisis talks with the head of the federal Department of Health and Ageing, Professor Jane Halton, over the unprecedented walkout of clinical advisors from the nation’s decade long $1 billion effort to build a functional eHealth system.
Held on Tuesday, the meeting followed calls by AMA president Dr Steve Hambleton for Professor Halton to intervene and take a “personal focus” on why highly respected eHealth clinical advocate Dr Mukesh Haikerwal and several other medical advisors suddenly parted company with National eHealth Transition Authority (NeHTA) after a decade of attempting to make eHealth an everyday reality.
The situation that is emerging is that DoHA, assisted by contentious technology consulting and services firm Accenture, are poised to take on far more control and work to finally deliver software end-products to doctors and hospitals leaving an existential question mark over the future of NeHTA.
-----

We’re from the government …. we have no idea how to help you

The promise of a personal medical record accessible to everyone involved in a patient’s health care sounds like a wonderful idea. And if the system actually worked – it would be! Tests wouldn’t be duplicated, hospitals would know the full list of diseases that the GP was treating and GPs would know all the medication changes that hospitals and specialists instigated.
Of course the more complex a system, the bigger the chances that something will go wrong. So the development of the PCEHR (Personally Controlled Electronic Health Record) was always going to be difficult. Medical groups were worried whether the information on the file would be accurate; IT experts were worried about whether the security levels would be robust enough; consumer groups wanted patients to be able to control who could and couldn’t have access to any aspect of the record.
The danger with a asking a committee to design a horse is that you end up with something that looks like a camel. Although the government invested close to a billion dollars developing the PCEHR system, nobody involved has been really happy with the outcome. Several hundred-thousand people have registered to enrol in the system but in fact less than 5000 GP-written health care summaries have been created across Australia.
-----

Qld govt responds to payroll inquiry

  • AAP
  • August 20, 2013 10:56AM
THE Queensland government will prohibit state agencies from making significant information technology investments without ministerial approval to prevent another payroll disaster.
The new framework is the government's response to an inquiry's findings into the bungled Queensland Health payroll system.
IBM rolled out a flawed payroll system for Queensland Health in 2010, resulting in thousands of pay errors.
-----

Queensland payroll inquiry fallout: Ministers to sign off on big IT investments

The new framework is the government's response to an inquiry's findings into the bungled Queensland Health payroll system
  • AAP (Computerworld)
  • 20 August, 2013 10:44
The Queensland government will prohibit state agencies from making significant information technology investments without ministerial approval to prevent another payroll disaster.
The new framework is the government's response to an inquiry's findings into the bungled Queensland Health payroll system.
IBM rolled out a flawed payroll system for Queensland Health in 2010, resulting in thousands of pay errors.
-----

Minister to vet tech spending after Queensland Health payroll bungle

Date August 20, 2013 - 12:23PM
The Queensland Government will prohibit state agencies from making significant information technology investments without ministerial approval to prevent another payroll disaster.
The new framework is the government's response to an inquiry's findings into the bungled Queensland Health payroll system, dubbed the 'worst failure of public administration in this nation'.
IBM rolled out a flawed payroll system for Queensland Health in 2010, resulting in thousands of pay errors.
-----

Qld bureaucrats targeted over payroll mess

  • AAP
  • August 22, 2013 10:50AM
FIVE Queensland public servants face possible disciplinary action over their role in the disastrous health payroll debacle.
The Public Service Commission is examining what action should be taken against public servants adversely named in the Queensland Health payroll system inquiry report released earlier this month.
IT Minister Ian Walker told parliament on Thursday the commission's chief executive, Ian Maynard, has found five individuals should be issued show cause notices.
-----

Heads roll over Qld Health payroll debacle

  • AAP
  • August 23, 2013 10:34AM
A HANDFUL of highly paid public servants has been sacked and more are expected to be given their marching orders over Queensland Health's $1.2 billion payroll debacle.
Premier Campbell Newman says four or five workers involved in the sorry saga have had their contracts terminated in the past 24 hours.
"I'm not going to have people who have let Queenslanders down continue to hold, in many cases, high paying jobs in the public service," he told reporters on Friday.
-----

Plibersek gives GPs her pitch

22 August, 2013 Paul Smith
Federal Health Minister Tanya Plibersek has made many decisions that have had a direct affect on general practice.
Is freezing patients’ Medicare rebates good for Australia’s health? What has been her biggest achievement? And what will she do to reduce red tape faced by doctors? 
Australian Doctor asked the questions - here are her answers:
Aus Doc: You recently said that GPs were the “backbone of Australia’s world-class universal health system”. But the federal government will effectively cut the value of the funding for GP Medicare services with the indexation freeze.
It has already cut MBS funding for GP mental health items, as well as direct funds to GP practices for after-hours services. And has a plan to tax doctors’ CPD.
Is the government not in fact breaking the backbone of our world-class health system?
Plibersek: Government investment in primary care is at record highs, as is investment in the MBS. By increasing support for primary care, we’re better supporting the sector that has general practice at its heart.  We have also been leading consultation with the profession about the possibility of a Patient Centred Medical Home model for general practice in Australia.
-----

Wave-trap breakthrough to bolster cancer fight

THE performance of airport body scanners and cancer diagnostic equipment could be boosted by about 50 per cent using a new technique to detect T-rays (terahertz waves).
Researchers are using a novel structure to trap terahertz waves in tiny, micro-scale holes to produce a much higher contrast image than currently possible.
Terahertz waves are electromagnetic waves with frequencies between those used for mobile phones and for optical-fibre communications. When used for cancer detection, they are capable of distinguishing malignant from healthy tissues. They are also used for security scanners to see through packages and clothes.
-----

Health bosses share in $5.7m bonus

Date August 20, 2013

Noel Towell

Reporter for The Canberra Times

Top executives at the federal Department of Health and Ageing shared a $5.7 million performance bonus in the 12 months to June last year.
Staff at the department were told last week that it planned to cut 400 jobs as it struggled to rein in its spending in response to the latest increase in the Labor government's efficiency dividend.
But an analysis of recent departmental annual reports shows that the number of senior staff on salaries of more than $240,000 grew from 39 in 2011 to 53 last year.
-----

Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews

Leelani K Wickramasinghe, Peter Schattner, Marienne E Hibbert, Joanne C Enticott, Michael P Georgeff and Grant M Russell
Med J Aust 2013; 199 (4): 261-265.
doi: 10.5694/mja13.10161
Abstract
Objectives: To investigate whether General Practice Management Plans (GPMPs), Team Care Arrangements (TCAs) and reviews of these improve the management and outcomes of patients with diabetes when supported by cdmNet, a web-based chronic disease management system; and to investigate adherence to the annual cycle of care (ACOC), as recommended in diabetes guidelines.
-----

Business review: Windows 8.1

Date August 20, 2013 - 11:36AM

Rhys Evans

OPINION
Microsoft's focus on the consumer market with Windows 8 left enterprise users in the lurch. That should change with Windows 8.1.
The enterprise adoption of Windows 8 hasn't been good news for Microsoft at all. At the end of last month it had single-digit market share and Windows 7 still dominated the desktop market. Many organisations still need to migrate from Windows XP before Microsoft ends support for it in April, but they're migrating from XP to the more familiar Windows 7, rather than the newer OS.
One enterprise bugbear has been the lack of a start button. Without that button, accessing the start screen from the desktop required a mouse click on the bottom left-hand corner of the screen, loading the charms bar from the right or pressing of the start key. On a touch-screen device without mouse or keyboard this was difficult and not intuitive.
-----

Area 51: CIA says truth is out there

  • From: AP
  • August 16, 2013 11:58AM
THE CIA is acknowledging the existence of Area 51 in newly declassified documents.
George Washington University's National Security Archive obtained a CIA history of the U-2 spy plane program through a public records request and released it on Thursday.
National Security Archive senior fellow Jeffrey Richelson reviewed the history in 2002, but all mentions of Area 51 had been redacted.
-----
Enjoy!
David.

Sunday, August 25, 2013

AusHealthIT Poll Number 180 – Results – 25th August, 2013.

The question was:

Do The Resignations Of A Number Of The NEHTA's Clinical Leads Indicate Very Major Problems With The NEHRS / PCEHR Program?


No - All Is Fine 10% (7)

Possibly 8% (6)

Probably 25% (18)

For Sure - It Is Doomed 56% (40)

I Have No Idea 0% (0)

Total votes: 71

This is a pretty clear outcome. Almost 81% believe there is a major problem with the PCEHR Program. Seems confidence is at a major low.

Again, many thanks to those that voted!


David.

This Is A Really Excellent Article On The E-Health Machinations Going On In Canberra. A Careful Reading Is Warranted.

This appeared a day or so ago.

Doctors and DoHA hold eHealth crisis talks

Published on Fri, 23/08/2013, 09:40:42
By Julian Bajkowski
The Australian Medical Association (AMA) has held crisis talks with the head of the federal Department of Health and Ageing, Professor Jane Halton, over the unprecedented walkout of clinical advisors from the nation’s decade long $1 billion effort to build a functional eHealth system.
Held on Tuesday, the meeting followed calls by AMA president Dr Steve Hambleton for Professor Halton to intervene and take a “personal focus” on why highly respected eHealth clinical advocate Dr Mukesh Haikerwal and several other medical advisors suddenly parted company with National eHealth Transition Authority (NeHTA) after a decade of attempting to make eHealth an everyday reality.
The situation that is emerging is that DoHA, assisted by contentious technology consulting and services firm Accenture, are poised to take on far more control and work to finally deliver software end-products to doctors and hospitals leaving an existential question mark over the future of NeHTA.
Dr Hambleton told Government News described the meeting with Prof. Halton as “extraordinary.”
“Clinical utility will drive this thing,” Dr Hambleton said. “If we can’t get it from NeHTA let’s get it from somewhere else. We have got a railway line … we just don’t have any trucks.”
“We can’t be driven by the techos,” he said.
The metaphor of rail lines, and the attendant headaches they have caused the Australian Federation, appears to be a highly prescient one.
It is understood that a major driver for greater federal involvement is that state governments, particularly those held by the Coalition in Victoria, New South Wales and Queensland are now far less willing and financially able to plough in the cash resources required to make a doctor-friendly front-end appear.
Ironically, the latest hiccup comes despite much of the back-end infrastructure for eHealth already being in place.
“It’s not a big jump. We just have to make it happen,” Dr Hambleton said.
Either way, the support of what some Canberra bureaucrats cheekily refer to as the “doctor’s union” is essential for any eHealth scheme to work because state and federal governments simply cannot, nor want to, compel clinicians to use it.
Relations between DoHA, NeHTA and the doctors have been strained now for some months over apparent difficulties in providing a usable system interface that provides what clinicians term “clinical utility” - or the ability for the system to be used for practical work by doctors.
A number of informed sources have suggested that reticence of the big states to keep ploughing long-term financial resources into NeHTA through the Council of Australian Governments has effectively left Prof. Halton and DoHA in control of the wider eHealth delivery agenda by default.
“It’s a pretty desperate lot that they are left with,” one government source said.
Much more here:
On the basis that Dr Hambleton is being accurately reported I have to say I am concerned he is being rather more optimistic regarding where we are in terms of the quality and utility of the present e-Health infrastructure than I am at present. However I really think he is spot on in the diagnosis that without  ‘clinical utility’ the whole effort is doomed.
I also agree strongly with the comment that without real AMA support and commitment the e-Health Scheme is doomed to fail.
The sooner DoHA and NEHTA face up to this fact the better for all of us and the less money will be wasted.
As a general point I think that there are some really useful and sensible things happening in e-Health - some of which I plan to write about during the week - but I have to say the Federal Government interventions have been by far the least valuable and evidence based and have cost the most. Hardly a great recommendation for Government intervention in what is a complex health / technology space that requires a good deal more understanding than is presently apparent.
I note in passing that other e-Health interventions from DoHA in other areas such as the AMT are also going badly at present with the Government just ignoring the expert advice they are receiving and leaving patient safety under increasing risk.
David.